Personalised screening for women in early pregnancy could better predict pre-eclampsia
Personalised screening early in pregnancy could help doctors better predict who might be at risk for pre-eclampsia, according to a new study.
The condition is a type of high blood pressure that can be dangerous in pregnancy and is a leading cause of maternal death worldwide.
According to the UK’s National Health Service (NHS), preeclampsia affects two to five of every 100 pregnancies.
A new study of more than 7,000 women with first-time pregnancies suggests that a screening algorithm that includes maternal history, blood marker tests, and ultrasounds could help to identify a woman’s risk for pre-eclampsia in the first 13 weeks of pregnancy. Researchers used the Fetal Medicine Foundation’s (FMF) screening algorithm and found that it detected pre-term pre-eclampsia in 63 per cent of cases and earlyonset pre-eclampsia in 77 per cent of cases.
The screening had a false positive rate of 15 per cent.
It was better at identifying risk than guidelines from the American College of Obstetricians and Gynaecologists (ACOG), the researchers said, which had equivalent detection rates of 62 per cent for pre-term pre-eclampsia and 59 per cent for early-onset preeclampsia, with a higher false positive rate of 34 per cent.
The ACOG guidelines recommend that pregnant women take aspirin if they have a major risk factor for pre-eclampsia such as chronic high blood pressure or type 2 diabetes or if they have two moderate risk factors.
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‘Easier to make the right decision’
Researchers say when using the FMF model, treatment can be based on an individual’s personal risk.
“With their personal risk calculated, it’s much easier for a woman to make the right decision, for example, if she chooses to take daily low-dose aspirin, she is much more likely to follow through because it’s based on [a] personalised screening test,” Emmanuel Bujold, a senior study author and gynaecology professor at the Université Laval in Canada, said in a statement.
Published in the journal Hypertension, the study was carried out between 2014 and 2020 at five health centres in Canada. Fewer than 1 per cent of the participants developed pre-term and early-onset pre-eclampsia. Sadiya Khan, an associate professor of medicine and preventive medicine at Northwestern University in the United States, who was not involved in the study, said in a statement that a screening model in early pregnancy is “very helpful and can initiate conversations between the clinician and patient about strategies to optimise heart health”.
“However, challenges remain with implementation of models such as this one that integrate biomarkers that are not routinely assessed and may not be widely available, especially among people in vulnerable populations who are most likely to have the highest risk for preterm preeclampsia,” Khan said.
One of the study’s limitations was that several women with risk factors for pre-eclampsia were excluded from the research if they were already taking aspirin. Previous studies have shown that taking one low-dose aspirin daily can reduce the risk of preeclampsia. The blood samples were also analysed in a single laboratory, so the biomarkers were measured several weeks after the blood was drawn.